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Impaired response to treatment with tumour necrosis factor α inhibitors in smokers with axial spondyloarthritis.
Ann Rheum Dis. 2016 Mar; 75(3):532-9.AR

Abstract

OBJECTIVES

To investigate the impact of smoking on the response to treatment with a first tumour necrosis factor inhibitor (TNFi) in patients with axial spondyloarthritis (axSpA) in a real-life cohort.

METHODS

Patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA in the Swiss Clinical Quality Management Cohort were included in this study. The potential association between smoking status and differential response to TNFi in terms of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) was analysed using multiple adjusted longitudinal mixed effect models. Binary response rates at 1 year were assessed with multiple adjusted logistic analyses.

RESULTS

A first TNFi was initiated in 698 patients with axSpA with available smoking status and a baseline or follow-up BASDAI assessment, of which 490 (70%) had complete covariate data. In comparison to non-smokers, current smokers demonstrated significantly smaller reductions in BASDAI and ASDAS scores upon treatment with TNFi (0.75 BASDAI units and 0.69 ASDAS units less, p=0.005 and 0.001, respectively) for patients with elevated baseline C-reactive protein (CRP) level. This effect was numerically smaller in patients with normal CRP. The odds for reaching a 50% improvement in BASDAI response or the ASAS criteria for 40% improvement after 1 year were significantly lower in current smokers than in non-smokers (0.54, 95% CI 0.31 to 0.95, p=0.03 and 0.43, 95% CI 0.24 to 0.76, p=0.004, respectively).

CONCLUSIONS

Current smoking is associated with an impaired response to TNFi in axSpA.

Authors+Show Affiliations

Department of Rheumatology, University Hospital, Zurich, Switzerland.Swiss Clinical Quality Management Foundation, Zurich, Switzerland.King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark.Private Rheumatology Practice, Basel, Switzerland.Department of Rheumatology and Rehabilitation, Bürgerspital, Solothurn, Switzerland.Department of Rheumatology, Bethesda Hospital, Basel, Switzerland.Swiss Clinical Quality Management Foundation, Zurich, Switzerland.Department of Rheumatology, Cantonal Hospital, St. Gallen, Switzerland.Division of Rheumatology, Uniklinik Balgrist, Zurich, Switzerland.Department of Rheumatology, University Hospital, Geneva, Switzerland.Division of Rheumatology, Uniklinik Balgrist, Zurich, Switzerland.Department of Rheumatology, University Hospital, Zurich, Switzerland.Department of Rheumatology, University Hospital, Geneva, Switzerland.No affiliation info available

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25667205

Citation

Ciurea, Adrian, et al. "Impaired Response to Treatment With Tumour Necrosis Factor Α Inhibitors in Smokers With Axial Spondyloarthritis." Annals of the Rheumatic Diseases, vol. 75, no. 3, 2016, pp. 532-9.
Ciurea A, Scherer A, Weber U, et al. Impaired response to treatment with tumour necrosis factor α inhibitors in smokers with axial spondyloarthritis. Ann Rheum Dis. 2016;75(3):532-9.
Ciurea, A., Scherer, A., Weber, U., Exer, P., Bernhard, J., Tamborrini, G., Riek, M., Müller, R. B., Weiss, B., Nissen, M. J., Kissling, R., Michel, B. A., & Finckh, A. (2016). Impaired response to treatment with tumour necrosis factor α inhibitors in smokers with axial spondyloarthritis. Annals of the Rheumatic Diseases, 75(3), 532-9. https://doi.org/10.1136/annrheumdis-2013-205133
Ciurea A, et al. Impaired Response to Treatment With Tumour Necrosis Factor Α Inhibitors in Smokers With Axial Spondyloarthritis. Ann Rheum Dis. 2016;75(3):532-9. PubMed PMID: 25667205.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impaired response to treatment with tumour necrosis factor α inhibitors in smokers with axial spondyloarthritis. AU - Ciurea,Adrian, AU - Scherer,Almut, AU - Weber,Ulrich, AU - Exer,Pascale, AU - Bernhard,Jürg, AU - Tamborrini,Giorgio, AU - Riek,Myriam, AU - Müller,Rüdiger B, AU - Weiss,Bettina, AU - Nissen,Michael J, AU - Kissling,Rudolf, AU - Michel,Beat A, AU - Finckh,Axel, AU - ,, Y1 - 2015/02/09/ PY - 2013/12/21/received PY - 2015/01/06/accepted PY - 2015/2/11/entrez PY - 2015/2/11/pubmed PY - 2016/6/21/medline KW - Ankylosing Spondylitis KW - Disease Activity KW - Smoking KW - Spondyloarthritis SP - 532 EP - 9 JF - Annals of the rheumatic diseases JO - Ann. Rheum. Dis. VL - 75 IS - 3 N2 - OBJECTIVES: To investigate the impact of smoking on the response to treatment with a first tumour necrosis factor inhibitor (TNFi) in patients with axial spondyloarthritis (axSpA) in a real-life cohort. METHODS: Patients fulfilling the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA in the Swiss Clinical Quality Management Cohort were included in this study. The potential association between smoking status and differential response to TNFi in terms of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS) was analysed using multiple adjusted longitudinal mixed effect models. Binary response rates at 1 year were assessed with multiple adjusted logistic analyses. RESULTS: A first TNFi was initiated in 698 patients with axSpA with available smoking status and a baseline or follow-up BASDAI assessment, of which 490 (70%) had complete covariate data. In comparison to non-smokers, current smokers demonstrated significantly smaller reductions in BASDAI and ASDAS scores upon treatment with TNFi (0.75 BASDAI units and 0.69 ASDAS units less, p=0.005 and 0.001, respectively) for patients with elevated baseline C-reactive protein (CRP) level. This effect was numerically smaller in patients with normal CRP. The odds for reaching a 50% improvement in BASDAI response or the ASAS criteria for 40% improvement after 1 year were significantly lower in current smokers than in non-smokers (0.54, 95% CI 0.31 to 0.95, p=0.03 and 0.43, 95% CI 0.24 to 0.76, p=0.004, respectively). CONCLUSIONS: Current smoking is associated with an impaired response to TNFi in axSpA. SN - 1468-2060 UR - https://www.unboundmedicine.com/medline/citation/25667205/Impaired_response_to_treatment_with_tumour_necrosis_factor_α_inhibitors_in_smokers_with_axial_spondyloarthritis_ L2 - https://ard.bmj.com/cgi/pmidlookup?view=long&pmid=25667205 DB - PRIME DP - Unbound Medicine ER -